A federal judge in Oregon rejected Health and Human Services Secretary Robert F. Kennedy Jr.’s attempt to cut Medicare and Medicaid funding for hospitals that provide gender-affirming care to minors, finding he exceeded his authority and skipped required rulemaking in Oregon v. Kennedy, No. 6:25-cv-02409-MTK.
The written opinion from U.S. District Judge Mustafa T. Kasubhai, filed April 18, grants summary judgment to a multi-state coalition that sued over the funding move. The ruling records what Kasubhai first said from the bench: the secretary’s declaration tried to change law without using the formal regulatory path the agency must follow.
Kasubhai did more than parse procedure; he rebuked the secretary’s approach and its tone toward legal norms. That sharp language stands out because judges usually stick to technical findings, but this opinion reads like a stern warning about executive shortcuts.
“Unserious leaders are unsafe.”
“This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty.”
Those lines will get attention across the political spectrum because they turn a procedural ruling into a public rebuke. Conservatives who oppose irreversible medical interventions for minors can still agree that the administration must follow the law. Process matters: winning on policy by flouting statutory steps hands opponents an easy legal victory.
The Oregon decision did not appear in isolation. In Rhode Island, U.S. District Judge Mary McElroy issued a preliminary injunction blocking the administration from terminating $11 billion in public health grants, finding the government had overstepped Congress’s spending power. Together, those rulings suggest federal courts are pushing back not on policy per se but on attempts to achieve policy by bypassing notice-and-comment rules and statutory limits.
That pattern is significant for conservatives who have long argued that the administrative state must respect its procedural fences and Congress’s authority. Proper notice-and-comment rulemaking, clear statutory authority, and fidelity to Congress’s appropriations power are core conservative legal commitments. When agencies skip those steps, even good ends lose their legitimacy.
The practical effects of federal pressure are already visible in the health sector. Hospitals and programs have adjusted practices after investigations and scrutiny. Children’s Minnesota paused puberty-blocking drugs for minors following federal attention, and NYU Langone closed a transgender youth program after sustained review. Those outcomes show federal influence without needing to break the law.
But the Oregon and Rhode Island rulings make a key point: pushing institutions through investigations and oversight differs from changing entitlement funding by proclamation. If the secretary believes Medicare and Medicaid should not support certain treatments, the legal route is clear. Follow the Administrative Procedure Act, publish a proposed rule, take comments, and justify the change in the record.
Conservatives should be blunt about consistency. The rule of law protects policy outcomes as well as liberty, because it forces transparency, evidence, and accountability. If the administration’s goal is popular with the right, pursuing it through proper rulemaking is the way to lock in durable reforms that survive judicial scrutiny.
The administration still has options. It can appeal Judge Kasubhai’s ruling or begin the formal rulemaking process required to alter funding conditions. Either choice would refocus debate on the underlying policy question — whether taxpayer dollars should fund gender-related procedures for minors — but it must happen inside the legal framework Congress set.
Court decisions can be reversed, limited, or upheld, and that uncertainty matters. A past controversy shows lower-court rulings do not always stand on appeal, which means conservatives who want long-term policy wins must insist on getting process right. Shortcuts invite reversible losses and political blowback.
For now, the Oregon decision preserves Medicare and Medicaid payments to hospitals treating minors with gender-related care, not as an endorsement of the treatment but as enforcement of procedural rules. If the administration wants a lasting policy change, it needs the paperwork, the public record, and a rule that can withstand the rule of law.
